Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives

Abstract

Background: Although community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention. Methods: This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach. Results: Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C. programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs. Conclusions: Understanding and considering community members' and healthcare providers' views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.

Unlocking Trust in Community Health Systems: Lessons From the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

“…We therefore observe, like others, that identifying and engaging community members who truly represent the community in delivering health interventions may promote uptake of health services by increasing trust between health providers/ health system and communities. 17,44 Use of locally appropriate channels and actors in the dissemination of health information has the potential for reducing mistrust in health systems by minimizing room for doubts and misinterpretation of health messages. 13,44 Trust in healthcare systems and providers has been identified as an important social factor that influences healthpromoting behaviors and utilization of health services.…”

Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia

“…21 Involving the community not only ensures utilisation but also facilitates accountability in FP/C services provision. 23 However, facilitating participation in FP/C services will require building trust in FP/C methods/services: for example, promoting facilitative strategies that address structural failures such as the feminisation of FP/C services. 23 …”

“… 23 However, facilitating participation in FP/C services will require building trust in FP/C methods/services: for example, promoting facilitative strategies that address structural failures such as the feminisation of FP/C services. 23 …”

“… 37 , 40 Interventions to improve QoC must also address limitations at the organisational and community levels as efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account. 23 Governments should continue to implement and encourage incentives, perhaps performance-based, as well as strong regulatory and monitoring structures to ensure quality FP/C services. 41 Efforts to improve quality of FP/C services should also incorporate components of person-centred quality care such as dignity, social support and supportive care to have the highest likelihood for success.…”

Application of community dialogue approach to prevent adolescent pregnancy, early marriage and school dropout in Zambia: a case study

“…The need to strengthen efforts to prevent pregnancy among adolescent girls in sub-Saharan Africa has been increasingly recognized over recent years [ 9 – 11 ]. In Zambia the high prevalence of child marriage and teenage pregnancy greatly contribute to high fertility and population growth, and is closely interrelated with a range of economic and social determinants [ 12 – 14 ].…”